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The following category is for games rated AO (Adults Only) by the ESRB. AO is the highest and most restrictive rating by the ESRB: it is given to games that are considered to be appropriate for audiences 18 years and older. This generally refers to games with sexually explicit or pornographic content, but has been given to a few games with extreme violence.

ESRB-AO is the rarest of the ratings given by the ESRB. None of the three major gaming hardware companies in North America (Sony, Nintendo, and Microsoft) allow AO-rated games to be released on their consoles, most retailers refuse to stock these games, and Twitch has banned any and all live-streams of AO-rated gaming content.